Our Infertility Journey (1.17): Exploring Other Options…Adoption?

Dave was in the process of finishing up his residency program…finally! He was looking for a job and had been on several interviews. Although he had multiple job offers, nothing felt like the right fit. He had one more job possibility that sounded promising in Indiana. It was now December, and since we had been going through IVF non-stop since August we decided that we needed a vacation. An inexpensive vacation was the only thing that would fit our infertility sabotaged budget so we decided on Chicago (Yes, Chicago in December…we really are mid-westerners). Infertility treatments had actually bought us a free hotel room for the week. We had put all of our IVF cycles on our credit cards which racked up our Hilton Honor Points in no time. Over 30 grand has a tendency to do that. We decided to take a detour to Indiana on the way to Chicago for Dave to have the job interview. That way at least some of our travel costs would be covered.Home Finances

I didn’t want to take the chance of flying. We had already done some flying while I had been going through the IVF cycles, and I wanted to minimize any potential factor that may have led to a lack of success. Dave’s interview went very well. It was also very promising because if this cycle didn’t work, we had zero dollars to proceed with any additional cycles. This job offered a sizeable signing bonus that would allow us to continue with our infertility journey.Young woman stroking her belly becouse of bellyache

Unfortunately, it ended up that we were going to need the additional money. Once again, I started to spot, got moody, and knew that I wasn’t pregnant. The infertility nurse call now almost felt like a recording programmed into my phone, scheduled to recite after each cycle. That was the worst vacation. I felt sick. Sick from my period…sick from my infertility…sick from my increasing despair. I didn’t care about anything else. I just wanted a baby. Doubled over while sitting on the toilet, I cried tears of pain and tears of loss. Each failed cycle felt like miscarriages. Maybe they were. Maybe the embryos had only been present for the day they were transferred. I will never know.

My journey felt like it was coming to an end. I decided that we needed to explore other options. Maybe adoption was the right choice. This had been suggested by people all along the way. Some people didn’t fully understand my desire to have a baby that was “made” from Dave and me. Some didn’t understand my desire to be pregnant. People would throw out the comment, “Well, you could always adopt.”  As though the idea had never occurred to us. Yes, we could, but I wanted a baby from my own flesh and blood. I wanted to feel a baby moving in my belly.Pregnant Woman Holding Baby Shoes

Would I consider adoption if I had exhausted all efforts to get pregnant? Of course. What I wanted most was to be a mother, but, if I could have my own biological child, that was what I wanted. I wanted to look at his or her face and see something from me. I wanted to laugh at the characteristics that were from Dave. There is nothing wrong with adopting a baby. Actually, I am a huge advocate of adoption. I had often thought about adopting a child from an underdeveloped country. I still have that desire, but I also wanted to have the experience of giving birth to my own flesh and blood. I wouldn’t love my own flesh and blood more than an adopted child, but I just wanted a baby in my belly.Missing Child

People judge when you say these things, or they don’t understand. Some who have adopted feel that you are minimizing their love for their children or are undermining the choice that they made. I’ve heard people say that if adoption is good enough for them, then why isn’t it good enough for me? I feel that this is just a personal choice. We are all entitled to our opinion, and we all have different needs, wants, and desires. None of them are wrong. No one should be made to feel guilty that they want their own biological children, just like no one should be made to feel that their children are less valuable or loved because they are adopted.

I started to look at adoption organizations. Maybe that would be our only option. We discussed what it would be like to have a multiracial family. How would our families respond? How would our friends and neighbors interact with a baby that we adopted. We had been assured by all of them that they would love an adopted child just as much no matter what their race was or who their parents were. My coworker who struggled with infertility had decided that she also wanted to get pregnant. She had successfully gone through IVF several years before, but this time after two unsuccessful cycles she was ready to consider other options. She wanted to know that what she was investing in would actually result in a baby. Adoption seemed like the best option for them. Things were falling into place quickly for her. Could adoption be the best option for us too?Business man house in human hands

While focusing on our infertility, we also needed to focus on our future as physicians. Dave decided to take the job in Indiana. The signing bonus would mean that we could start from scratch with a new IVF cycle. Although at the beginning of my story numerous blogs ago, I mentioned that I was in this for the long haul, I was now starting to get very tired and weary. I had gained more than a few pounds from the hormones, steroids, bloating and from my overindulgence in comfort foods. I was used to the shots but was tired of being such a regular in the clinic. I hated having to rearrange my work schedule. I hated having to pick up extra shifts to make up for coming in late so many mornings. I hated having to take days off last-minute in order to have a procedure done. I was starting to wonder if this would ever work for us. I continued to pray. I also started to come to terms. Maybe it wasn’t in God’s plan for us to have our own biological children. Maybe he had a greater plan that I just didn’t understand.

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Our Infertility Journey (1.16): When Hope Outweighs Despair

I was starting to despair, but I had not yet lost hope. Despair is a terrible thing. It’s that sick feeling in your stomach that slowly creeps in. It makes you want to curl up in a ball and ignore the outside world. It makes you feel that your problem is the only and most important in the world. It definitely causes you to become self-focused. Holding onto hope was my only hope. I couldn’t despair. I had to trust that this would work. If I was negative about it what good would it do? Somehow the power of positive thinking was going to make a difference. I begged God. I cried. I pleaded. I told him that I was angry that he would do this to me. I had followed what I felt was a calling to go into medicine. I had dedicated my life to helping other people. Why wasn’t he helping me now? My anger turned into remorse. I apologized for anything and everything that I had ever done wrong. Was he holding out on me because of some unconfessed sin? I didn’t know, but I wanted to clear up anything that could possibly influence his response to my desperate cries for help.Anxious woman thinking in her bed next to her sleeping partner

I had to wait several weeks before starting the frozen cycle. All during this time I had been trying to act normal at work. Only a few people there knew what was going on. I didn’t want to make my private business public to the whole office (ironic since I’m now sharing it with the world). I didn’t want them to ask me how things went or to look at me with pity. I wanted to see my patients and then go home.

In primary care you get to know your patients fairly well. I sat down and started to ask my patient how she was feeling? I knew that she was pregnant. It hadn’t been planned, and she wasn’t all that happy about it. I had actually been the one to diagnose her pregnancy several months before. I then asked her how the baby was doing. She gave me a strange look, then glanced toward her young daughter who was playing in the room. She then whispered to me that she wasn’t pregnant anymore. Oh, I said, “I’m so sorry. What happened?” I assumed that she had a miscarriage. It didn’t even occur to me that she would have ended the pregnancy. All I wanted was to be pregnant, so the thought of giving that up was far from my considerations.Baby Holding Mans Finger

She responded in a whisper that she had an abortion. Now was not good timing to have a baby. Regardless of my position on pro-choice vs. pro-life (I’m not here to get into a debate. I am just sharing from my infertile perspective), in that moment, I felt like someone had punched me in the stomach. The only thought that kept going through my head was that, “I would have taken your baby. I would have loved your infant. If only you knew what a precious gift you had. I would give anything for that.” I swallowed my stomach, forcing it to go back to its normal position, and I responded without missing a beat. My face did not show my sorrow or my surprise, instead, just as medicine teaches us, it showed no signs of judgement. I simply said, “Oh, are you happy about that decision, and how are you feeling since the abortion?” I became objective because medicine mandates objectivity. As a physician I was forced to be objective and non-judgemental, but as a desperate woman wanting to become a mother…I grieved.

The beautiful thing about the frozen cycles was that I didn’t have to do a stimulation cycle. This meant that I only had to do a portion of the shots, and I had to take steroids. Unfortunately, the protocol for frozen cycles was that the progesterone had to be given as shots…Not the small needles, but the intramuscular shots in the butt twice daily. Usually, the spouse was the one to give these shots because it was a little hard to reach the correct spot on yourself. Besides, the needles were like torture devices. No one in their right mind would want to see that going into themselves. I surely didn’t. They had to be spaced out by 12 hours, one in the morning and one in the evening. The problem was Dave’s schedule. As a surgery resident, he was getting up at 4:30 in the morning in order to leave by 5 on certain days. I am not a morning person to begin with. Just imagine being awakened just so that you can bend over and have someone drive a needle (two by four) into your butt cheek.

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The first time I was incredibly nervous. It was about as bad as I thought that it would be. Having your husband inflict pain on you makes you somewhat more of a wimp as well. You have to put on a brave show for someone you don’t know, like a nurse, but you can whine and complain and say what you really feel when it is your husband. I am not one to get light-headed and woozy at the sight of needles, but after the first shot, I had to lay down…immediately (I’ve since gotten a lot tougher:) I thought that I was going to pass out. That sensation did not diminish over time. With each shot I felt more than a little flushed and light-headed. Then my butt began to get pretty sore. I started to have a pretty red spot on each cheek and decided that someone should take a look to make sure nothing was wrong. It turns out, that my husband has a very precise aim. He was giving me the shots in exactly the same spots every single time. You don’t really want this much precision! He was instructed to widen his aim to prevent a site reaction from getting worse.

It hurt to sit, and it hurt to stand. I started to long for the Crinone progesterone gel that turned into a cottage cheese curd-like discharge. It may have been gross and messy, but it certainly didn’t hurt like this. I decided that I could do anything at this point though. I could even give myself the shots; And, well, I had to. Dave was running late one evening (as in I don’t think he left the hospital until the next day.) I was on a strict schedule with my shots, and I wasn’t about to mess things up. I didn’t really have anyone else to ask, and I didn’t want any of my neighbors seeing my assets. My coworker had mentioned that because of her husband’s schedule she also had to give herself the IM shots at times. If she could do this so could I! I loaded the syringe, attached the mile long needle and prepared to self-inflict torture. I had to contort my upper body while looking in the mirror in order to make sure that I was in the right spot and wasn’t going to hit a nerve. After several start and stop attempts, I just decided to get it over with. The funny thing was, it was so much better when I gave it to myself than when Dave did it. It’s like getting your own splinter out. Somehow it just hurts less.

Transfer number three was scheduled. Again my primary infertility specialist was not going to be present for it. Instead it would be the head of the department. I was informed that his technical skills were very good, and we shouldn’t have a problem this time. Well, that was not entirely true (I’m sure his technical skills are fine…but we still had a problem). All three of the embryos survived the thawing process. The plan was to transfer all three because frozen cycles are known to have lower success rates than fresh.The Equipement Of Gynecologist Room

Striped down, knees in the stirrups, ultrasound smashing my belly once again, the transfer started, only to be started and stopped several times. The physician confirmed that my cervical pathway was more than a little tricky. It was winding and somewhat challenging to feed the catheter through. I lay there with my legs in the air panicking. Not again! They had to get the embryos in. The concern was that embryos are very temperamental to their environment. They should either be in the incubator, or they should be in the uterus. Any time out of these environments could compromise their quality and ability to survive. Eventually, the infertility specialist was able to get the catheter in place. The embryos were transferred, and we had three embryos floating around in my uterus. The idea that we could get pregnant with triplets and even as many as six babies put me into a little bit of a whirlwind; But, who were we kidding, we hadn’t been able to get pregnant once yet, so what where the odds that we would get pregnant with three?

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Our Infertility Journey (1.15): Fresh Embryo Transfer…second time’s the charm?

Several days after my egg retrieval, my uterus was ready for my second ever embryo transfer. When we heard that we had 6 embryos we were ecstatic. That sounded like so many compared to the last time. However, on arrival we were down to 5. They had decided to transfer only 2 embryos to minimize our risk of twins, but the two were perfect quality! Finally, we were going to be parents! My infertility specialist was in another procedure that day and was unavailable to perform the transfer. Instead, one of her partners was present for the procedure.

I was back in my striped from the waist down position with my legs in the air; I was ready to have this work. My legs started to cramp and get numb after a while, and the ultrasound probe was more uncomfortable than I had remembered. There was so much pressure pushing down over and over again against my sore ovaries that had just been poked with needles numerous times. Time after time, the physician attempted to pass the catheter tube into my uterus. The embryos were handed to her and then passed back to the incubator. She just couldn’t make the tubing work. Several times she unconvincingly thought that she was in the right spot, only to then conclude that she was not. Back and forth the embryos went.Sperm injection

I was starting to get nervous. This was supposed to be the easy part of the procedure. Tiny capillary tube in, baby in, presto…pregnant. Eventually, the nurse, who by now I considered a friend and who was holding my hand on the opposite side from Dave, suggested that we call my primary infertility specialist to let her try. Thankfully, she was able to come down from the operating room. A wave of relief swept over me when she entered the room. Not, that the other physician wasn’t good, but there’s a trust that develops between a doctor and a patient over time. I trusted my primary infertility specialist. I had researched her and chosen her as my doctor. Her knowledge level was great, but her surgical and procedural skills were also top-notch (which is why I had chosen her in the first place). She quickly moved into position and got to work. Unfortunately, my cervix decided that it wanted to be tricky for her as well. After at least another 15 minutes and several different types of tubing, she was in! In went the embryos. We waited for the confirmation from the embryologist that none were left in the tube. Yes, we were once again with child!

I got up from the table, desperately, needing to pee. Their protocol said that I didn’t need to lay flat, or put my legs in the air, or anything special. I could get up and go about my day as usual, but I still wasn’t allowed to exercise due to my ovary size. I was thrilled. This was going to work. Two great looking embryos were now inside of me. They were my little munchkins. I texted my friends letting them know how things had gone. We were only a week away from Thanksgiving, and we were going to Charlotte to see my parents for the holiday. I couldn’t wait to hear the words, “You’re pregnant.” We just had to make it through Thanksgiving and then we would know.

Our trip in Charlotte was fun. Everyone was excited for us. It was going to work this time because the medications had been so much better, the embryos looked much better; and well, it was just going to work. We decided to take a day trip to the Biltmore house. On the way home, Dave took a curb while pulling into a gas station. He didn’t just bump it a little, no, I felt myself lurch in the seat, with my seatbelt tightening. I freaked out! How could he be so careless? I couldn’t be jostled! What if he had just ruined everything that I had worked for? I went a little insane on him and then just stopped speaking the remainder of the way home. I don’t like getting angry, but I had so much riding on this cycle. It wasn’t like it was easy for us to get embryos. Every step had been challenging. He reassured me that everything was fine, and that it would take more than a speed bump to disrupt things. I didn’t want to hear a word of it. Although I eventually forgave him, I was a little nervous that it may have messed up our chances. I was probably blowing things completely out of proportion, but when you are on a gazzoodle of hormones and you have as many emotional and physical ups and downs as I had, you would probably have freaked out as well.

I was at work when the call came. It was my infertility nurse. She had been assigned to me from the beginning, and it was a good thing. I called her quite often when I had a concern, and she was the one who called me with my blood work results and my pregnancy test results. She was the one to hold my hand during the procedures, and she was the one saying “Hi,” to me each morning before my countless ultrasounds. She had called me with the news on my first cycle informing me that I wasn’t pregnant. She had a way of delivering the news that was very predictable. She always started with my name. She would say, “Emma, this is Libby (changing her name for privacy sake).”  And, then she would repeat my name and my results. “Emma, you are not pregnant.”  Followed by a sincere, “I’m so sorry.”

I had gone in that morning for a pregnancy test. Libby was calling with the results. Unfortunately, once again, I already knew what they would be. I had been feeling crampy for several days, and I was having a little bit of spotting. My munchkins had decided not to stay. I felt like they had betrayed me. Libby’s voice confirmed my concerns. “Emma, you’re not pregnant. I’m so sorry.” I was heart-broken. How could this be? This time had been better. This time had been as good as it would get. I called Dave to let him know, but I couldn’t reach him. Typical. He was working. I simply left him a message saying, “It didn’t work. We aren’t pregnant.”a woman blowing on a dandelion muted colors vintage toned

My infertility doctor called me as well to check on how I was doing with the news. We discussed options once more. At least this time we had frozen embryos so I wouldn’t have to go through a stimulation cycle again. And, of course, the price was much less for doing frozens. My gunner attitude pushed me to ask when we could get started again. I would have to wait a little while, but they could start me on birth control and once I had a period we could proceed with a frozen cycle. I was game. I do have to say that the periods after a failed IVF cycle are MONSTROUS. The medicines make the lining of the uterus thicker to support the embryos, but that means that you have more lining to shed. Fun, Fun! Not only are you not pregnant, but you get the worst period of your life. Oh, wait did I already mention that above? It’s worth mentioning again.

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Our Fresh Embryo Transfer (1.13)…baby making made easy????

I was so excited. I was expecting great news from our first-ever egg retrieval. Instead, I was told that only three of the eggs had fertilized, and of those three only two had survived. I had been counting on dozens of left over embryos to freeze for the future. Instead, we only had two. Although I was discouraged, I was also encouraged. Two embryos were all that we needed. I would take them!Two baby boys playing on bed

Several days later we headed to the hospital for our fresh embryo transfer. This is when embryos are placed through a tiny capillary catheter into the uterus. My personal infertility specialist was the one scheduled to perform the transfer rather than any of her partners, which gave me an immense sense of relief. Now that I was an “interesting” patient, with soaring estrodial levels and swollen ovaries…everyone knew me. I had broken records. I was off the chart! No longer one of many, I was distinct. It is strange how something bad like ovarian hyperstimulation can actually work in your favor. Being known made the process easier and meant that I received more time and dedicated attention from all of the doctors. In spite of this, I was still relieved that it would be my own doctor doing the transfer. She knew me the best, and I trusted her the most.

The transfer wasn’t supposed to be painful. It was a quick in and out. They actually said that I didn’t even have to stay laying on my back at all. I could get right up and head to work if I wanted to. I didn’t want to. Were they crazy?  I wanted to go home and put my feet over my head. I wanted those embryos to stick and stay!

We arrived to the procedure room early in the morning. My husband, Dave, was thankfully able to get the time off of work. We were making a baby…yes, the unromantic way, but we were still making a baby. As the nurse brought us back, she told me to undress from the waist down-yet again, and she handed Dave his baby-blue paper jump suit and surgical cap. As I was starting to strip down and Dave was starting to layer up, the nurse announced the sad news that we now only had one remaining embryo. The second one had not survived. I was heart-broken.Baby Fetus Newborn Over Isolated White Background. New Born Chil

One embryo decreased our chances of success by at least 50%, maybe even more. As it was, the chances of success had only been about 50%; now they were down into the 30’s. I gave myself a mental pep talk, but all the time I felt like someone had just punched me in the stomach. As my doctor prepared for the transfer, the nurse pressed the transabdominal ultrasound uncomfortably over my overly full bladder and hyperstimulated and swollen ovaries. I was fairly certain that I was going to start peeing right in my doctor’s face! I felt like I needed to warn her just in case I was about to embarrass myself and soak her. She reassured me that I wasn’t going to urinate. I remained skeptical and started cursing the darn ultrasound. It felt worse than the transvaginal. How was that even possible?

It took a little while longer than expected to get the catheter in place, but once in, the embryo was shot into my uterus. I was with child. A baby was inside of me. Now it was time to wait and see if it would attach and grow. There was nothing more that I could do other than wait.Questions, questions, questions... the Concept photo

Waiting. Waiting. Waiting is such a hard process. I prayed more than I ever have. I pleaded with God to let this work. I prayed that the baby would be healthy. I made promises to God that I probably couldn’t even possibly keep, but I wanted him to know that I meant business. I knew that he could make this happen. He could control the situation. Why he had put me in this situation in the first place I didn’t understand, but I knew that he could rectify it. I figured that I had already learned so much. I had grown so much. I realized my human fragility and my need for divine intervention. I waited, and I waited, and then…..I started spotting. And then, I started hemorrhaging with a full-out worst period of my life. My one little embryo had not survived. My womb was empty once again.Woman having a stomachache sitting on sofa at her home

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Our Infertility Journey (1.12): Do men always get the easy infertility jobs???#GivingTuesday

My nerves were intense, evidenced by the slight tremor in my hands. Annoyed that I was letting myself show any signs of vulnerability, I shoved them under my thighs. I was tough. A needle into my ovaries couldn’t be that bad, right? So what if I would be awake! The Ativan and pain meds would take the edge off. They had assured me that anesthesia wasn’t necessary (nor was it an option).

How long would they make us wait? The clock hands seemed to be stuck in the same position that they had been in when we entered the waiting room. I wasn’t as nervous about the procedure as I was about the outcome. The unknown mocked me. I despised my inability to control ANYTHING. I couldn’t will my body to create more eggs, to respond more favorably to the stimulation medications, or to stop hyperstimulating. All that I could do was wait and hope for amazing news.Young woman stroking her belly becouse of bellyache

At least Dave was at my side today. Over the past several months his presence at my appointments had been hit or miss-most of the time miss. As a doctor in training he didn’t have the luxury of frequent time off. I understood, but I still hated it. I had to accept that we were not making a baby TOGETHER. I was making a baby with needles, doctors, nurses, labs, and countless medications. This was one more frustrating reality, added to my list of things that I was powerless to change.

His presence today was absolutely necessary. An egg without sperm is just an egg! The door opened and Dave’s name was called. It was time for his contribution. Back to the male suite he went to squirt into a cup once more. If only my role were that easy. I felt a twinge of jealously and anger but quickly willed myself to dismiss it. What good would a pity party do? No, I had to stay focused. I needed to be positive. But, in the midst of my positive thinking I still couldn’t dismiss the recurring thought that it wasn’t fair! Maybe he wasn’t propping his feet up all day long, but he certainly wasn’t feeling the full effect of infertility. relaxing

I was starting to feel groggy by the time that Dave returned to the waiting room…with an extra spring in his step. The Ativan was kicking in. The door opened again. It was my turn. Once in the procedure room the nurse told me to change into a gown and to remove everything except for my socks. Dave was given a blue paper jump suit and booties to put over his clothes. As I was stripping he was zipping up. The room was frigid. Icy. Sterile. I shivered as I covered my head with the blue surgical cap. My legs were shaking.Woman Having Eggs Removed As Part Of IVF Treatment

The nurse arrived to start my IV line. My first poke of the day felt like a tickle in comparison to what was to come. As I slipped my feet into the stirrups, I took a deep breath and braced myself for pain. My bladder was overly full and I couldn’t help thinking how horrible it would be to urinate all over the floor. The ultrasound smashing against my abdomen didn’t help the situation. I was about to celebrate as the abdominal ultrasound was removed, but before I could utter my thanks, the vaginal ultrasound probe appeared. This probe was unlike the others…equipped with a special needle that would poke through my vaginal wall, reach over to my ovaries, puncture each individual follicle, and then apply vacuum suction to remove the eggs. Great…a torturous version of the traditional vaginal ultrasound probe! I hadn’t thought it possible to dislike an ultrasound probe any more than I already did; my opinion quickly changed.

Each time suction was applied the tube was given to the embryology lab technician who then confirmed if an egg was present or not. If present, a number was called out, adding to the tally. I felt like a contestant on The Price is Right. I kept guessing how many eggs we would get. I held my breath with each needle poke. My heart sank each time our count stayed the same. Would we have enough? Would they fertilize? I squeezed Dave’s hand and asked for more pain medication. The procedure was painful…if I hadn’t mentioned that. I felt every needle poke. The pain meds took the edge off, but puncturing the follicles located along the wall of the ovary definitely hurt the most. I held my breath, clenched my jaw, and prayed for it to be over quickly.Nurse Aiding Egg Retrieval Proceedure In Theatre

The narcotics running through my IV made my head and my body feel sluggish and heavy. I forced myself to listen for the final count…9 or 10. Not huge, but still good! We were done. I tried to wiggle over to the recovery gurney, but my body was too heavy, weighted down by the narcotics and Ativan. I couldn’t talk. Opening my mouth took too much effort. I felt myself being lifted and then wheeled down a hallway toward recovery.

Eight hours later I awoke, sore and nauseated. The narcotics had knocked me out, changing what should have been a 1-2 hour recovery time into a day long stay. As I slowly opened my eyes, I found that I was alone. I looked for a balloon, flowers, a card. Nothing! It may sound silly, but I had specifically told Dave that I wanted a giant balloon at my bedside. I’m not sure why it was so important to me, but it was. Other than his presence and some sperm, it was the only thing that I had asked of him for the retrieval. He had forgotten.Crying woman

Actually, he had gone back to work after I made it to the recovery area. Yes, I had been asleep, but I still wanted his presence at my side. Instead, I was surrounded by an overwhelming sense of aloneness. It was only a few minutes before Dave walked through the door. The first thing out of my mouth was, “Where is my balloon?!?!” I was livid. After everything that I had been through, I wanted some extra compassion and gratitude, something to say, “Thank you for everything that you are doing to get us pregnant.”

Dave really is a considerate and amazing husband, but even he will say that he fell short on this occasion. He left my bedside once again, but this time he returned with a giant monkey balloon, a children’s book, and a matching stuffed animal. The name of the book was, “I Love Monkey”. It was the silliest looking monkey I had ever seen with a flat face, the tiniest feet, and little striped socks. When he said that he had bought it for our baby to be, I couldn’t help but smile and forgive him. While his infertility role was not as physically or even emotionally challenging as mine, living with a wife pumped up with hormone injections was probably not the easiest job either. He too was learning as he went.Sad woman is talking to the phone in bad, in home.

I was back to work the next day; feeling very sore but hopeful. We were in the process of making beautiful embryos! We waited expectantly for the phone to ring. How many embryos would we have? What would their quality be? We waited and we waited. Finally, the call came.

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Our Infertility Journey (1.11): The Neighborly Infertility Waiting Room

As soon as my ovaries shrank back to their normal size (after a failed IVF cycle, sabotaged by ovarian hyperstimulation); my hormone levels normalized; and I had my period, I was immediately ready to start another cycle of IVF. I was going to make this work. I was not going to be discouraged. I was going to get pregnant.Pregnant Woman holding her hands in a heart shape on her baby bu

I was fertile…incredibly fertile…confirmed by a tiny drop of medication overstimulating my ovaries.  I didn’t need a break. I needed a baby. And, so, we started over again. This time I was required to have more frequent ultrasounds and more frequent blood draws (oh, so convenient for my work schedule). The medication doses were titrated to push the ovaries to make follicles but not to hyperstimulate. We were on the right track. But…

Once, again, I hyperstimulated. It was not as intense this time. I was able to continue the cycle, but unfortunately because we were using such small doses of medication I ended up with a lot of very small follicles that didn’t have eggs at the right stage of maturity. I only had a few follicles that looked promising. Would these few follicles be enough? I held onto hope.

During this cycle, a somewhat random and awkward series of events transpired. As I made my way into the clinic one morning, I noticed a familiar face. Not just a vaguely familiar face, but the face of my next door neighbor. She sat alone, looking down at either her phone or a book, or anything just to avoid eye contact. I knew that she had seen me. How could she not, with only a glass wall to separate us on entry, and one other person sitting in the waiting room?Three patients sitting in doctor's waiting room

For several months now I had observed that everyone always looked up when someone entered the waiting room. Maybe they look out of curiosity. Maybe it was an instinctive reaction to the sound of the door opening. Maybe they thought the nurse was about to call their name, or maybe it was a glance longing for connection-the connection of seeing someone else struggling with the same grief that infertility brings. In this silent community of women, all were pained by similar emotions yet distanced from one another by shame or a desire for privacy. But, behind each heart filled with pain was also a yearning for understanding and support.

As I sat down, I tried to make eye contact. Instead of feeling like my privacy was being invaded, I was excited to find comradery. I wanted to know my neighbor’s story. I wanted to tell her mine. I eased myself into the seat, sore from my distended pelvis. I wondered if she was in the middle of a cycle. As my mind was racing through possible scenarios, she briefly glanced my direction. I tried to catch her eye and smile. This time she did see me, but instead of saying hello and exchanging pleasantries, she simply gave me a hasty, half-hearted smile and quickly looked back down. Each morning after was the same.Outdoor profile portrait of a beautiful thoughtful Chinese Asian

I didn’t judge her. How could I? Just months before I had been shrinking behind the vending machine hoping that no one that I knew would see me. How could I expect her to behave differently. She hadn’t invited me into this private part of her life. She didn’t want me to know her struggle. She deserved the right to her privacy, to her reaction, to her annoyance at my presence. I understood. She was dealing with her infertility struggle in the way that worked for her. Who was I to pressure her to talk or to share?

Over the next several months we saw each other frequently. Our exchanges were limited to a quick glance and a brief smile. By now our husbands were accompanying us to our appointments whenever they could. My neighbor’s husband would smile and greet me comfortably, as though we were both in our front yards watering flowers. Our husbands worked out in the same gym and would run into each other on occasion. Somehow they were easily and openly able to talk about our simultaneous infertility journeys and failed IVF cycles.

Young woman doctor in cap and face mask in surgery room interiorAs coincidence would have it, we both ended up having our egg retrivals on the same Saturday morning. So, just the four of us sitting in the fish bowl waiting room at 6 am, eager, worried, and more than a little tired. Would we both come out of this round pregnant? Would only one of us have success? How many eggs would each of us get today? How many embryos? So many questions…so many what if’s. I wasn’t sure what to say. Besides, my mind was more than a little hazy from the sedating medication I had taken before arriving to the hospital. This clinic expected you to be tough. A benzo by mouth and some IV narcotics were all they gave for egg retrievals. Looking back, I’m a little jealous of my friends who had full anesthesia at other clinics! I’m pretty sure I’d be okay with never knowing what an egg retrieval feels like!

From The Mom in Me, MD

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It’s a Hush, Hush Word…Infertility

SHHHHHHHH…..I’ve got INFERTILITY ISSUES! People put autism puzzle stickers and breast cancer survivor stickers on their cars, but I have yet to see an “Infertile Couple” awareness sticker. Is the diagnosis of infertility any less of a diagnosis? Insurance companies lead us to believe this by their lack of coverage for medically necessary infertility services (a blog for another day).  Although infertility may not be life threatening like breast cancer, it is a painful and limiting condition that profoundly impacts many lives.NEW YORK - MAY 24: Actress Sarah Jessica Parker attends the prem

I assume that the stigma of infertility in part stems from the fact that SEX is broken. Who wants to admit that their sex doesn’t “work”? And, although Sarah Jessica Parker may have normalized talking about explicit sex over the dinner table, many of us don’t want to share the intimacies of our relationship with friends, let alone strangers. In my mind, one of the beauties of intimacy is that it is something shared just between my husband and me. And, although I don’t shy away from joking about sex with friends now and then, I don’t make it a habit to share what I do in private. Talking with girl friends about periods, child-birth, and boobs is no big deal. But, infertility doesn’t naturally or comfortably fall into that “normal” girl talk.

Our culture is inundated with sexuality, but the idealized kind filled with Victoria’s Secret Angels, Tatum Channing physiques, and Ryan Gosling charm (okay, and physique!) Infertility is poor performing sexuality. Who wants to talk about that? Not men, and not most women. No, men hate bringing up (sorry for my choice of words here) their struggles with erectile dysfunction. Most aren’t even able to verbalize their complaint. Instead, they just point at their crotch and stutter, “I can’t, umm,” followed by a fill in the blank. And, in the past 15 years I have only had one woman come to me concerned over her lack of orgasmic ability.Lovers

Thus, infertility falls into the hush, hush sensitive topic category. It is sensitive, but the shame and stigma associated with it prevent women and men struggling with infertility from getting the resources and support that they need. Breast cancer used to have a similar stigma associated with it. Women should not openly talk about their breasts! How improper! Yes, it was cancer, but the “unmentionable” kind. Thankfully, the shame that used to accompany the diagnosis of breast cancer has been diminished due to proactive campaigns encouraging and empowering us to embrace our womanhood, “feel our boobies,” and kick cancer in the butt. This change in culture has led to life saving advancements in breast cancer research and treatments.

Can a similar cultural revolution transform how infertility is viewed? Yes, but only if people are willing to step outside of their comfort zones. If thirty year olds still refer to their genitalia as their “junk,” how are we going to have a real conversation about infertility. Using real words and talking about real life problems is a good starting place. Acknowledging that the human body often fails us, and that infertility is one of these physical and biologic failures that is out of our control, lessens the stigma, even if slightly. Normalizing the idea that infertility is incredibly common may also empower men and women to open up more readily about their struggle toward parenthood. The more that people talk about this culturally uncomfortable issue, the less uncomfortable it will become.Group of multiethnic babies crawling isolated on white backgroun

Reducing the stigma of infertility will positively and powerfully impact the infertility world. Infertile couples will have a larger support system if more people are willing to share their stories. This in turn will lead to increased social networks and social capital. With increased unity focused on the cause of infertility, more money will be raised for research, leading to improved infertility treatment options. Awareness campaigns may lead to political activism, forcing insurance companies to take infertility seriously and cover necessary treatments. Imagine a world where people have increased fertility because of improved infertility treatments and insurance coverage! If population control is your thing, then this may not excite you. But, for those of us hoping to add to the human race, this thought is utopia!

From The Mom in Me, MD

 

Our Infertility Journey (1.10): The “Gunner” in Me…and My Ovaries

I expected things to feel differently. I knew that my ovaries would be working overtime with all of the hormones, so I brushed off the full feeling in my pelvis as “normal.” But as soon as my feet hit the floor on the second week of my IVF cycle I knew something wasn’t quite right. I jumped up and down a little bit beside the bed just to confirm my discomfort. Taking my dog, Bentley, for a short walk around the block confirmed my fears. Every step felt like a jab into my lower abdomen. I could feel each footstep as though it was kicking me in the belly. I had peritoneal signs.Young woman stroking her belly becouse of bellyache

Most people wouldn’t be familiar with this term, but I had routinely ruled this symptom in and out in belly pain patients presenting to my office and the emergency room. Peritoneal signs meant that I now had free-floating fluid sloshing around in my abdomen and pelvis. In my case, this fluid was coming from my ovaries. I was hyperstimualting! This may not sound like a big deal…but it can be. Not only does ovarian hyperstimulation cause discomfort, it can be very dangerous. Ovaries can get so large that they twist on themselves, cutting off their blood supply and ultimately dying if not surgically corrected quickly enough. Body fluids can spill into the abdominal cavity and fluid can pour into the lungs compromising breathing and even leading to electrolyte disturbances (potassium and salt imbalances). If severe enough, ovarian hyperstimulation syndrome can lead to kidney failure, blood clots, and even death.

My risks were low. I wasn’t too old. I wasn’t too young. I wasn’t too skinny, and I wasn’t to heavy. I didn’t have polycystic ovary syndrome. I was a model patient for IVF. This couldn’t be happening! But, it was. My estrodiol levels were off the charts and climbing! Just stopping the medications wouldn’t necessarily stop the hyperstimulation right away. These medications would continue to work for hours and even days before they would no longer have an effect on my ovaries. Moving forward with the IVF cycle would only make things worse and compromise my health and safety. It was over. The only option now was to cancel the cycle and wait for my ovaries to calm down. Wait…Wait…Wait…Woman Suffering From Stomachache On Sofa

What now? That was my big question. Over a week of shots, thousands of dollars spent, and nothing to show for it except for a medical complication….what now? I needed a plan. I needed an answer. I needed to know that we could move forward. If IVF wasn’t an option, then what was?

Although my infertility specialist had used tiny doses of the stimulating medication on me since I was considered fertile (funny for someone undergoing infertility treatments!), my body’s response to the small doses was like a rocket launching for the moon. The next time around I was told that we would simply use even smaller doses of the medications. I was ready. “Sign me up. When can we get started?” Those were my most pressing questions. In medicine, this mentality is referred to as a “gunner”-someone who is dug into the trenches ready to give it their all no matter the cost. I was an infertility gunner.Close Up Of Woman Inject Drugs To Prepare For Treatment

I had been gunning for things for years-medical school, residency, Hopkins admission-this wasn’t any different…other than that it matter so much more. Motherhood mattered more to me than any degree or job ever could. I longed for a baby more than I had longed for anything. As soon as my ovaries calmed down, I gladly grabbed my injections ready to get started again. IVF was my ticket to motherhood, and I was going to make it work. I had to…what other option did I have? Guns blazing was going to be my style. I warned Angelina Jolie to watch out; I was about to steal her role for Mr. and Mrs. Smith II. The baby making scenes weren’t going to be quite as sexy…but we WERE going to make a baby!

From The Mom in Me, MDShot of a sexy military woman posing with guns.

 

 

Our Infertility Journey (1.9): Keeping My Head Down and My Hopes Up

Armed with my vials, needles, syringes, and injection pen, I was ready to get started. I prided myself on being tough; and in truth, since I don’t have an abnormally intense fear of needles or blood, the shots were not that bad. After the first self-administered shot, poking myself four times a day became part of a “normal” routine. Yes, it hurt, but I figured if my diabetic patients could give themselves as many shots as they did for a lifetime, I could do this for a few weeks.Abdomen Subcutaneous Insulin Syringe Pen Injection Vaccination

I start off using ice to numb the injection area, but eventually that was just a nuisance. I usually talked to myself out loud just to prepare myself before the poke. It was a quick pep talk reminding myself that, “You can do this! It will be over in two seconds. etc. etc.” A quick poke and burn, and then another poke and burn and I was done. When my stomach started to feel a little like a pin cushion I tried rotating spots; but even so, I bruised with each one. I didn’t mind. I was going to make a baby!

My schedule was dictated by the shots. I had to get a cooler to put them in just in case I wasn’t home when I needed to administer them. I did have Dave try to give me a shot early on just to see if it would make the experience better. Definitely not! Somehow, having control over hurting yourself makes it less painful.

Three patients sitting in doctor's waiting roomNow came the tricky part-trying to work my schedule at work around the IVF clinic schedule. The IVF clinic didn’t offer appointments. It was first come first serve starting at 7:30 or 8 in the morning depending on the doctor. They had instructed me that some women, in an effort to get to work on-time, would get to the waiting room as early as 6 am to sign in. That sounded insane to me. Why wouldn’t they just offer appointments. How inconvenient! You would never know when you would be seen with this set up. I had my own patients to see twenty-five minutes down the road! How was I going to come in for daily ultrasounds and blood draws without knowing my timing? The answer…show up to the waiting room before anyone else. So, that is what I did.

I raced through the parking lot each morning as fast as my feet could carry me.  If I saw the familiar face of another infertility patient I picked up my pace. I needed to get my name in first. I had other people depending on me. I couldn’t change my patient schedule everyday. It wasn’t fair to my patients and their needs.

We usually all ended up on the same elevator ride up to the third floor of the hospital. No one made eye contact. We all knew where we were going and why, but somehow talking about it just seemed like a violation of our privacy. The real though was who was going to get off of the elevator first to put their name at the top of the list. We all had jobs. We all had places to be. No one wanted to seem rude, but everyone jockeyed for position.Outdoor profile portrait of a beautiful thoughtful Chinese Asian

Often the lights were off in the waiting room. The heat had been turned up to an ungodly temperature, and the only people passing in the halls were surgery residents-many of whom knew me. I would quickly sneak to the coveted position in the room-the seat next to the vending machine in the corner. Here I was somewhat safe and out of sight.

We worked on an unspoken honor system. When the nurse finally arrived to take attendance she would start by asking who got there first, second, third etc. Each infertility patient would chime in with their name when their position was called. It was all about who walked through the waiting room door first. No one ever tried to steal a spot. The rush through the door might have been somewhat hostile, but once seated…everyone knew their position in line.

This waiting room should have been filled with comradery, with moral support, and ultimately with friendship. Unfortunately, our emotions were too raw. We each sat with our heads down, our hearts heavy, and our minds consumed with INFERTILITY. We were cautiously optimistic. We held onto hope. We held onto our fairytale dream of a happy ending. If only we had been brave enough to hold onto each other as well…it might have made the journey just a little easier.elegant girl with umbrella sitting on antique chair in the mount

From The Mom in Me, MD

 

Our Infertility Journey (1.8): Needles Here…Needles There…Needle Pokes Everywhere!

I was nervous but excited to start IVF. This was our chance to make a baby! I stared at the needles, willing myself to see them as a golden ticket to motherhood rather than a necessary evil. The nurse pulled out her sample syringes and models. She demonstrated how to draw up the medication from the vial and then how to inject the needle like a dart into my belly or leg. I could do this. What was a little poke in the belly?

She then moved onto shot number two which would stimulate my ovaries. This shot came as a dial-up pen that I would use twice daily. I simply had to attach the needle, dial to the correct dose, and then stab myself again in the belly or leg. The nurse recommended using my belly as much as possible. Since the abdomen has more subcutaneous fat it causes less bruising and is a little less painful. She told me that pinching my skin a little would help prevent bruising, and applying an ice-cube to numb it might help minimize the sting.Beautiful woman is doing injection herself. In home.

The final shot was the big one…progesterone. Unlike the others which used a short needle, this shot had to be injected in the bottom twice daily with a 2 1/2 inch long needle! Yikes! My other option was a creamy gel that I could squeeze into my vagina twice daily. I opted for the creamy gunk! I could put up with panty-liners for a few weeks.

After I was given my prescriptions, I headed to the pharmacy. Thankfully, since my husband was an employee at the hospital we got a huge break on the medications. What should have cost us several thousand dollars only cost several hundred. This was a relief considering we would soon be paying our large upfront deposit for the cycle.

This med center was pay as you go for infertility treatments. They didn’t have the lump packages like some medical centers and private clinics. In those packages you get a break for paying for several cycles up front. If you get pregnant on the first cycle, then you lose a pretty chunk of change. But, if you aren’t pregnant, then it’s a good thing that you bought the discounted insurance package because you can get right back to it. For many plans if you aren’t pregnant after 5 cycles, then you get your money back! What a deal! One of the problems with this scenario, however, is that getting pregnant and carrying a baby to term or delivery are two very different things. Pregnancy rates don’t equal baby in your arm rates.Happy Mother Breast Feeding Her Baby Infant

So, I was okay that our center just did the traditional pay as you go. They of course required a chunk up-front. We looked through our finances and decided that we would just have to make it work. What other option did we have? Ten to 15 thousand dollars was a huge chunk of change to us, but I had gotten a bonus at work, and we had been saving diligently since we had started residency. We told ourselves that it would be worth every penny even if it cost us our savings. Besides, if it didn’t work the first time, we would most likely have frozen embryos left over that we could use in a subsequent cycle. Frozen cycles only cost about $1500. What a bargain!

I rushed home to put the medications in the fridge. My period eventually came after what seemed like forever; how ironic that I was now hoping for my period to arrive. I was ready to start the shots. I pulled out my medication and opened the box of follistem, assuming that the injection pen would be included. It was not. As I examined the medication box I noted that it clearly said, “Pen not included.” The pharmacy was now closed. The IVF clinic was closed. This was the day based on my cycle that I had to start the medication! What was I going to do?

I quickly looked for the physician on-call number. I paged the physician and waited…and waited… and waited. I paged the number again. After 2 hours I received a return call from a resident. Yes, I had just been a resident one year prior, but I wasn’t in the mood to talk with someone who wasn’t an infertility expert. I was paying too much money and had too much on the line to speak with a novice.Couple of doctors talking and using a tablet computer

Unfortunately, a novice is exactly what I got. It must have been her first day on the infertility rotation because she had no clue about the medications. I calmly explained that I could not give myself the shot without the pen. She explained that the pen should have been with the medication. Back and forth we went. I asked how I could get the pen. She then simply said I should use a syringe to draw up the medication. But, I calmly explained that the follistem vials were only to be used with the pen.Money in syringe

She then tried to educate me on how to draw up medication. I had to stop her there. I tersely informed her that I was a physician and knew how to draw up medication, and I knew what the pen looked like. I was not confused about how to do it, and NO, I did not have the pen in my possession! Since she didn’t have a clue how to get me a pen, her advice was to call the clinic in the morning to sort things out. By now I was more than frustrated and irritated. I couldn’t wait until the morning. I needed a correct answer right now…not just a guess at what should be done. For $15,000 I felt entitled to concierge care not a first year intern’s best guess.  I asked her to page the attending on-call. When she balked at the idea (because most attendings don’t want to be bothered on a Friday evening) I told her that I wasn’t suggesting this…I was demanding it. I’m usually pretty laid back, but in that moment, the combination of infertility, an empty bank account, and a box of needles and meds that I could do nothing with pushed me over the edge.

She wasn’t pleased with my authoritative attitude, but she agreed to touch base with them. Oh, the poor resident! It is so hard learning on the job. I am sure that she had her strengths, but she just wasn’t yet familiar with the infertility process. I didn’t want to be too hard on her. Goodness, I had my own moments of weakness as a resident.

After another hour, the now timid resident told me that the IVF clinic should have given me the pen at my education session. The pharmacy didn’t carry them. I would have to push back the medications by a day and get the pen in the morning at the clinic before work. The mix up was a result of the usual training nurse being on vacation the day that I had been trained on the medications. The fill in nurse thought that the usual nurse had given me the pen. Clearly not!

Now I had to run to the opposite side of town to pick up the pen before I headed to work in the morning. Since I hadn’t pushed back my own schedule of patients, I would now have an incredibly unhappy waiting room full of patients. I rushed to the hospital bathroom stall, hiked up my skirt and stabbed myself with the pen. What a way to start my first cycle of IVF.Abdomen Subcutaneous Insulin Syringe Pen Injection Vaccination

From The Mom in Me, MD